North Carolina Should Legalize Safe Injection Sites

Safe Injection Sites and the Opioid Epidemic

Since his election last November, Attorney General Josh Stein has made tackling the opioid epidemic a top priority. Some of the measures Stein and the Cooper administration have taken to combat the crisis’s hold on North Carolina communities include expanding access to naloxone and initiating an investigation of the pharmaceutical industry. One crucial tool missing from Stein’s efforts so far, however, is safe injection sites. Also known as supervised injection facilities, these locations provide opioid addicts the opportunity to inject drugs with clean needles provided by the facility and under the supervision of medical professionals. They are part of the harm reduction approach towards combatting the opioid epidemic, a set of strategies meant to mitigate the negative consequences of using drugs and to encourage respect for the rights of members of society addicted to drugs. Countries like Germany, Switzerland, Australia and the Netherlands have operated legally-sanctioned “fix rooms” as early as the 1980s, while Vancouver opened North America’s lone safe injection site in 2003.

Safe injection sites have only recently become a legislative possibility in the US. In January, Seattle officials approved the nation’s first site in response to its growing problem with drug addiction, and the city council recently allocated two million dollars in its 2018 budget to finance a “safe consumption site reserve”. A bill to introduce a site in San Francisco was narrowly struck down by the California state senate in September, but a city task force has since recommended that multiple facilities be opened in the area to curb its rising public drug use. The North Carolina legislature has not yet considered the idea, despite the state being home to four of the top 20 cities in the US with the worst rates of opioid abuse per capita. Wilmington boasts the highest rate in America, with 11.6% of its residents abusing prescription opiates. If Attorney General Stein hopes to reduce these figures, he and the rest of North Carolina’s lawmakers must recognize that safe injection sites are a critical step towards doing so.

Saving Lives at Low Cost

Safe injection sites are an extremely controversial proposition. Proponents of their use argue that they reduce many of the harmful effects associated with drug use, like fatal overdoses and disease transmission. Critics claim their presence leads to higher populations of drug addicts in their surrounding communities and thus a greater burden on the “productive” members of society. If this phenomenon were accurate, it might be a decent argument against establishing safe injection sites. Similarly, limiting the rights of individuals to shoot up legally would be justified if the actions of these individuals harmed others by bringing about more crime and other undesirable effects to their communities. However, studies assessing the effectiveness of safe injection sites have repeatedly found that they place no additional burden on the members of society. Establishing safe injection sites does not lead to increases in crime, higher populations of drug addicts, or more new addictions.

A 2006 study examined the aforementioned Vancouver safe injection site and found, “There were no obvious differences between the two years with respect to the various indicators of drug-related crime.” The authors also noted their results replicated those of a study conducted on Australia’s first supervised site in Sydney, which found no proportional increase in drug use or supply offenses since the location opened. Another study on the Vancouver site concluded that addicts who frequently attended the location sought treatment more quickly afterwards, a result that contradicts the popular belief that safe injection sites discourage drug addicts from seeking help. Since these negative effects often believed to be associated with safe injection sites are more myth than reality, continuing to ban these sites based on these perceptions alone borders on the same malpractice that created so many addicts in the first place.

While safe injection sites are not proven to have negative effects on communities, they are an invaluable resource for those addicted to drugs who would otherwise be shooting up with dirty needles and without anyone close by to make sure they don’t accidentally stop breathing. Further research on Vancouver’s safe injection site found a drastic decline in fatal drug overdoses in the close vicinity of the facility; the analysis showed a 35% reduction in mortality within 500 meters of the facility after its opening in 2003. A 2009 report on Switzerland’s harm reduction strategy, which has consistently included safe injection sites, noted, “Deaths from AIDS among people who used illicit drugs and other mortality among drug users (from overdose and other causes) dropped precipitously from the early 1990s to 1998.” The country also saw a sharp decline in the number of injection-related HIV infections throughout that same period.

As these results and countless others indicate, safe injection sites provide potentially life-saving benefits to the individuals who frequent them. Facilities in Canada and Switzerland have contributed to declines in fatal overdoses and injection-related infections, both of which are serious harms that often warrant government intervention in other social realms. By continuing to ban safe injection sites, the US federal government, and the North Carolina legislature by extension, are failing to reduce harm to individuals. Limiting these individuals’ right to use drugs safely could even be viewed as a contributing factor to the harms they experience otherwise, as addicts face greater risks of disease and death in the absence of safe injection sites.

North Carolina’s Best Course of Action

All things considered, legalizing safe injection sites would be a worthwhile public health effort for the state of North Carolina. They are proven to reduce fatal overdoses and HIV/AIDS transmissions, thereby reducing harm to individuals, and the ethical arguments against their legalization are unfounded. If the narrative that safe injection sites cause social harm to others were accurate, their prohibition would be justified. Since this is not the case, however, continuing to ban these facilities is only hurting the drug-addicted individuals who need them most, and in many cases, the cost they pay is their life. North Carolina is home to many of these individuals and communities in dire need of safe injection sites, and its government must set aside the false narratives and legalize these life-saving facilities as soon as possible.